Dear Lactnet Friends:

Heather sent me a copy of the von Stumm study. After I read it, I went to
look at the AHRQ meta-analysis  and am sharing with you all what I
discovered.  Hang on to your hats!

von Stumm et al.  starts out incomplete: while ARA and DHA are part of the
IQ foundation, there is so much more to breastfeeding than that
(relationship, brain building proteins etc. etc.)

Lucas study of premies was conclusive; none of the premies were breastfed.
They either got human milk or formula in the tube. As someone posted on
Lactnet, there is a lot more evidence supporting the impact of human milk
and breastfeeding on IQ. If I recall correctly, the first studies came in
the 1920s or 1930s.

The way that breastfeeding is defined (Y/N) is weak, to say the least.
 "Breastfeeding. At first contact when the twins were on average 18 months
old, mothers were asked a whether they had breastfed their twins (yes/ no).
The question was asked including
both twins and not for each twin separately. Mothers also reported how long
they had breastfed each twin in days. The correlation of breastfeeding
duration across twins was .97."  Nothing else about breastfeeding
exclusivity or duration?

Average duration of almost 4 months?  Again, nothing about exclusivity.
Considering how precise the numbers are about all the measures of IQ,
"almost 4 months" is imprecise.

(It is worth it to breastfeed anyway, because the world needs smart
women!!!)

"However because the observed effects were weak and at best modest, we
interpret the findings as evidence for the lack of any benefits of
breastfeeding on cognitive development from early life through
adolescence."  So small effects =  no benefit???


However, on an interesting note, the AHRQ meta-analysis done by the CDC in
the US in 2007 says this about IQ:

"Conclusion:  On  well-performed sibling analysis and prospective studies
that controlled specifically for maternal intelligence demonstrated that
there is either little or no evidence for an association between
breastfeeding and cognitive performance in children. It is clear that
maternal intelligence is a major confounder in the studies on relationship
between breastfeeding and cognitive development. For those studies that
still reported a significant effect after adjustment for maternal
intelligence, residual confounding from other factors like different home
environments cannot be ruled out. Many studies controlled for socioeconomic
status and maternal education but not specifically for maternal
intelligence. It is clear that maternal intelligence should be controlled
for separately from socioeconomic status and maternal education in any
studies of breastfeeding and cognitive development. As cautioned by Der et
al., “The generalizability of the results presented here must be considered
carefully. This study and the others included in the meta-analysis are all
based on samples from developed countries. Generalization of the findings
beyond these and similar societies would be unwise. We have also excluded
premature and low birthweight infants for whom the effect may be different."

This is what the AHRQ meta-analysis says about preterm feeding and IQ:

"Conclusion:  No definitive conclusion can be made regarding the
relationship between breast milk feeding and cognitive development in
preterm infants. One meta-analysis reported a five points advantage in
standardized mean score and one systematic review identified one primary
study that reported an eight points advantage in IQ in preterm or low birth
weight infants who received breast milk feeding. In three of four primary
studies of moderate quality that controlled for either maternal education
or maternal intelligence, the advantage from breastfeeding was reduced to a
statistically non-significant level after adjustment; the fourth study
reported a positive association between duration of breastfeeding and the
Bayley MDI at 12 months after controlling for maternal intelligence and
home environment. The roles of maternal intelligence and home environment
should be accounted for in future studies on breastfeeding and cognitive
development. Keeping in mind that cognitive function measured at an early
age is not necessarily predictive of later cognitive ability, one should
also consider carefully the timing and the selection of appropriate testing
instrument in future studies. In addition, clear subject selection
criteria, controlling for differences in early complications of prematurity
and its relation to receiving breast milk, accounting for subjects lost to
follow up, clear distinction between direct breastfeeding and bottle/gavage
feeding of breast milk, collect data on breast milk fortifiers or
supplemental preterm formulas, and better data collection on breast milk
feeding after discharge from the neonatal units will improve the quality of
these studies."

Hm m m. . .seems like von Stumm's study had poor methodology in its
vagueness about breastfeeding; and still, stumbled on a upsetting
conclusion.

There is a lovely study about parenting in the Journal of Perinatology,
"Breastfeeding, Parenting, and Early Cognitive Development" by Gibbs and
Forste, (J Pediatr 2014;164:487-93).

Here's what the abstract says:

"Objective: To explain why breastfeeding is associated with children’s
cognitive development.

Study design By using a nationally representative longitudinal survey of
early childhood (N = 7500), we examined how breastfeeding practices, the
early introduction of solid foods, and putting an infant to bed with a
bottle were associated with cognitive development across early childhood.We
also explored whether this link can be explained
by parenting behaviors and maternal education.

Results There is a positive relationship between predominant breastfeeding
for 3 months or more and child reading skills, but this link is the result
of cognitively supportive parenting behaviors and greater levels of
education among women who predominantly breastfed. We found little-to-no
relationship between infant feeding
practices and the cognitive development of children with less-educated
mothers. Instead, reading to a child every day and being sensitive to a
child’s development were significant predictors of math and reading
readiness outcomes.

Conclusions Although breastfeeding has important benefits in other
settings, the encouragement of breastfeeding to promote school readiness
does not appear to be a key intervention point. Promoting parenting
behaviors that
improve child cognitive development may be a more effective and direct
strategy for practitioners to adopt, especially for disadvantaged children."

In the face of such evidence, we might have to let the IQ bit go. What
matters most is parenting and having a healthy baby (now that's where
breastfeeding is so powerful).

What do you all think?


warmly,

Nikki Lee RN, BSN, Mother of 2, MS, IBCLC, CCE, CIMI, ANLC, CKC
Author:* Complementary and Alternative Medicine in Breastfeeding Therapy*
www.nikkileehealth.com
https://www.facebook.com/nikkileehealth

*Get my FREE webinar series*

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